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I had Doppler ultrasound that showed more than 60% blockage in celiac and sma arteries. CT showed narrowing of both and it was determined I had celiac compression syndrome. I had surgery in September, on ligament with no stent of either celiac or the sma which was also narrowed due to atherosclerosis. Post prandial pain is better but still have diarrhea, nausea, etc. Is it possible to still have chronic mesenteric ischemia with atherosclerosis in the infrarenal aorta and the SMA? I was told at least 2 of the 3 mesenteric arteries had to be narrowed to cause symptoms or qualify for stents.

Answer:

Celiac compression syndrome, also called median arcuate ligament syndrome, is characterized by abdominal pain which is usually, but not always, related to eating. It may be associated with weight loss and often times a clinician can hear a noise in the abdomen when listening with a stethoscope (this noise is called a “bruit”). The condition is thought to be due to compression of the celiac axis artery by the median arcuate ligament, which is a portion of the diaphragm that crosses over the aorta in the area of the celiac axis. The condition is somewhat controversial because studies have shown that some healthy patients, with no symptoms, also have some degree of celiac artery compression by the median arcuate ligament. The actual cause of abdominal pain is the subject of debate. The diagnosis of celiac compression syndrome or median arcuate ligament syndrome is one of “exclusion.” This means that every other possible condition that might be causing abdominal pain and weight loss should be ruled out before making the clinical diagnosis of celiac compression syndrome. The treatment is surgical and involves cutting away the portion of the diaphragm, which is compressing the celiac axis artery. Some surgeons also remove the celiac ganglion which is the plexus of nerves in that area (sometimes referred to as the “solar plexus”) because pressure on the nerves is thought to possibly be causing the abdominal pain. If there is severe compression of the celiac artery (meaning it causes more than 80% obstruction of the artery), many surgeons will not only cut away the ligament but also reconstruct the artery by either opening it and placing a patch on it to enlarge the artery, or by placing a stent into the artery.
There are three main arteries that supply blood to the small and large intestine as well as the stomach, liver, spleen, and pancreas. These arteries are the celiac axis, the superior mesenteric artery, and the inferior mesenteric artery. It is generally accepted that a narrowing of one of these arteries is not enough to cause abdominal pain after eating and that near-complete blockage of at least two of the three arteries is needed before the patient will develop abdominal pain. Diarrhea due to ischemic colitis would be unlikely in a patient who has a normal superior mesenteric artery and normal inferior mesenteric artery and a subcritical narrowing of the celiac axis (meaning less than 80%). As mentioned above, all other possible causes of abdominal pain or any other abdominal symptoms like diarrhea must be ruled out before attributing a patient’s symptoms to celiac compression syndrome.